Abstract 16145: Statin Prescription and Cholesterol Control Among Persons With HIV Without Existing Atherosclerotic Cardiovascular Disease

Abstract

Introduction: Persons with HIV (PWH) have significantly increased risk for atherosclerotic cardiovascular disease (ASCVD) including acute MI. The REPRIEVE trial recently demonstrated that statins reduce cardiac events in PWH at low-intermediate ASCVD risk. However, statins are underutilized even among PWH who are at high ASCVD risk. Accordingly, we sought to characterize current gaps in cholesterol management in a population of PWH and identify factors associated with statin prescription. Methods: We conducted a retrospective study of PWH 40 years and older without existing ASCVD at three HIV clinics in San Francisco, U.S. from 2019-2022. We used ICD-10 codes and electronic health record data to assess cholesterol screening and treatment. Multivariable logistic regression models evaluated clinical factors associated with statin prescription among those eligible. Results: The clinical cohort included 2,567 PWH, of which 14% were female, 54% White, 24% Hispanic, and 18% Black, with a median age of 55 years. Among those with complete data on the components of the ASCVD Risk Estimator, the median 10-year ASCVD risk was 7.6%. The majority of PWH (87%) had undergone cholesterol screening, and 43% were eligible for statin therapy based on current guidelines (Figure 1). Of the 1,097 PWH eligible for statins, only 478 (44%) were prescribed statins. Among statin-eligible PWH, statin prescription was positively associated with older age, antiretroviral therapy, undetectable viral load, and chronic kidney disease and negatively associated with hepatitis C. Cholesterol control (non-HDL cholesterol <130 mg/dL) was achieved in 47% of the study population. Conclusions: PWH in this study demonstrate suboptimal rates of statin prescription and cholesterol control. Identification of PWH eligible for statin therapy, prescribing statins, and ensuring lipid control are opportunities for improving primary prevention of ASCVD among PWH at heightened risk.